Family uses external review to overturn insurance denial

NBC NewsWednesday, December 10, 2025 at 11:49:13 PM
PositiveHealth
Family uses external review to overturn insurance denial
  • In North Carolina, a family successfully utilized the state's Smart NC program to overturn an insurance denial for a medication that significantly reduces their son's seizures, which has a list price of nearly $800,000 annually. This outcome reflects a broader trend, as more than half of insurance denials reviewed externally in the state are reversed.
  • This development is crucial for the family as it allows them access to necessary medical treatment that can improve their son's quality of life and potentially reduce the frequency of his seizures. The financial burden of such high
  • The situation highlights ongoing challenges families face in securing insurance coverage for essential medical treatments, as seen in other cases where coverage has been denied despite medical necessity. Additionally, recent policy changes in North Carolina regarding Medicaid funding indicate a shifting landscape in healthcare access and affordability, impacting many families across the state.
— via World Pulse Now AI Editorial System

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